Bill H.1019
188th (2013 - 2014)

An Act making greater use of managed care in Medicaid

Bill Title: An Act making greater use of managed care in Medicaid

By Mr. Donato of Medford, a petition (accompanied by bill, House, No. 1019) of Paul J. Donato and Thomas M. Stanley that the office of Medicaid be authorized to transition certain providers away from fee-for-service models of payment and towards greater use of alternative payment methods. Health Care Financing.

Chapter 224 of the Acts of 2012 is hereby amended by striking Section 261 in its entirety, and inserting in its place thereof, the following new Section:-

SECTION 261. Notwithstanding and special or general law to the contrary and to the greatest extent possible, the office of Medicaid shall transition providers who are capable of such a transition, away from fee-for-service models of payment, and towards greater use of alternative payment methods including but not limited to shared savings, bundled or episodic payments, or global payments. In developing such a program, the office of Medicaid shall consult with and the Medicaid managed care organizations, Senior Care Options plans, PACE plans, and Medicaid Medicare Integrated Plans under contract with the commonwealth to provide services to beneficiaries, and to the greatest extent possible utilize said Medicaid managed care organizations, Senior Care Options plans, PACE plans, and Medicaid Medicare Integrated Plans in implementing the requirements of this section.

In making the transition to alternative payment methodologies, the office of Medicaid, along with the Medicaid managed care organizations, shall achieve the following benchmarks, to the maximum extent feasible:

(i) Not later than July 1, 2013, reimbursement for at least 25 per cent of MassHealth enrollees that are not also covered by other health insurance coverage, including Medicare and employer-sponsored or privately purchased insurance shall be based on an alternative payment arrangement for members.

(ii) Not later than July 1, 2014, reimbursement for at least 50 per cent of MassHealth enrollees that are not also covered by other health insurance coverage, including Medicare and employer-sponsored or privately purchased insurance shall be based on an alternative payment arrangement for members.

(iii) Not later than July 1, 2015, reimbursement for at least 80 per cent of MassHealth enrollees that are not also covered by other health insurance coverage, including Medicare and employer-sponsored or privately purchased insurance shall be based on an alternative payment arrangement for members

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